| NPI | 1205064540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T4409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD222041) |
| 207Q00000X Family Medicine (Licence: CA C175408) | |
| 207Q00000X Family Medicine (Licence: WA MD61012547) | |
| 207Q00000X Family Medicine (Licence: MA 250127) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2024-11-27 |