| NPI | 1043390958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13150993-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A70358) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2023-01-31 |