| NPI | 1740251537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD26800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L1163) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2012-08-14 |