| NPI | 1780811158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q0929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.31760) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2018-07-24 |