| NPI | 1710307962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q5853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX A128889) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2016-07-25 |