| NPI | 1841443264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N5045) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N5045) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2016-09-22 |