| NPI | 1679735625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-6832) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2012-11-22 |