| NPI | 1972751360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10032395) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2016-03-16 |