| NPI | 1205254992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A14332) |
| Additional Taxonomies | 2086H0002X Surgery, Hospice and Palliative Medicine (Licence: CA 20A14332) |
| 2086H0002X Surgery, Hospice and Palliative Medicine (Licence: TX U1052) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2026-02-25 |