| NPI | 1821003591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M6509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 35745) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2014-12-05 |