| NPI | 1982604385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K9186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E2134) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2007-07-14 |