| NPI | 1346651718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A16565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q6529) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2023-12-22 |