| NPI | 1821000225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0149) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 630031H) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2018-09-10 |