| NPI | 1740299619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 0882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX LL3351) |
| 207Q00000X Family Medicine (Licence: ID 0-46) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2007-07-08 |