| NPI | 1174519151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7359423-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G27601) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2015-12-09 |