| NPI | 1093701054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1726) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A89614) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2016-12-28 |