| NPI | 1942612783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q7301) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10051108) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2016-03-22 |