| NPI | 1760645352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0432) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-6612) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2011-07-18 |