| NPI | 1881645216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 237947) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2013-03-18 |