| NPI | 1083785976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R8977) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A92406) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2022-03-04 |