| NPI | 1790928232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4939) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 204837) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2013-09-23 |