| NPI | 1932398377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N2078) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10028866) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2017-01-18 |