| NPI | 1104890318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E9028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C40883) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2010-12-21 |