| NPI | 1316234941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A117812) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10032487) |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2019-05-17 |