| NPI | 1730409939 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N9688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10037203) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2014-05-15 |