| NPI | 1952597510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L1650) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX L1650) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2014-08-21 |