| NPI | 1871606780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N0290) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00040815) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2008-08-28 |