| NPI | 1831417039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60389136) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2015-01-13 |