| NPI | 1720216476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10035632) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2012-11-30 |