| NPI | 1871721993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2949) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL1273) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2015-07-06 |