| NPI | 1922009208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 9413) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M5999) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2016-03-15 |