| NPI | 1972617678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 378894-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3265) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2013-02-05 |