| NPI | 1942452255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301092671) |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2012-05-17 |