| NPI | 1275530826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P3000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A81044) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2012-10-22 |