| NPI | 1760576680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F4282) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: TX F4282) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |