| NPI | 1295172856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A129556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T7026) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2024-07-03 |