| NPI | 1700919578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L3281) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 18994) |
| 208000000X Pediatrics (Licence: TX L3281) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2009-07-24 |