| NPI | 1881603587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K7889) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00001952) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |