| NPI | 1770613507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P6574) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 49101) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2014-05-20 |