| NPI | 1316327125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A156032) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R9299) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2020-07-31 |