| NPI | 1942452123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N2806) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX as4134665-9262) |
| Enumeration Date | 2008-10-19 |
| Last Update Date | 2015-09-16 |