| NPI | 1932493624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7269) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10041304) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2014-05-08 |