| NPI | 1851325823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX MO818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M0818) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-08-21 |