| NPI | 1881862357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP1-0028452) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2011-05-12 |