| NPI | 1922380708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2013-0397) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N8280) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2013-10-11 |