| NPI | 1235365750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N9950) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A123927) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2024-05-14 |