| NPI | 1861831034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1655) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10047964) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2016-06-15 |