| NPI | 1831545938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R4903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10057226) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2017-11-15 |