| NPI | 1215997259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K9983) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G67483) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2024-07-30 |