| NPI | 1699973420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX J4168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J4168) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2012-08-05 |