| NPI | 1184809949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A109537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 6825146-1205) |
| Enumeration Date | 2007-12-29 |
| Last Update Date | 2013-03-27 |