| NPI | 1982877387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01064472A) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2009-01-29 |