| NPI | 1831532241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q8972) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10047345) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2016-11-03 |