| NPI | 1033135066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M5168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A94376) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2008-01-29 |