| NPI | 1710974811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 1330) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2014-03-17 |