| NPI | 1174801179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 11353427-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A13265) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2023-12-11 |