| NPI | 1972863231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.206659) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP1-0044182) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2017-02-10 |