| NPI | 1831325380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R7182) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101245776) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2018-11-07 |