| NPI | 1992935456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P3886) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301094544) |
| Enumeration Date | 2009-07-18 |
| Last Update Date | 2014-09-11 |