| NPI | 1063971240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20003) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11839167-1204) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2026-09-21 |