| NPI | 1902035801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P2115) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10035420) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2016-03-03 |