| NPI | 1891087102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10039553) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2018-05-03 |