| NPI | 1356633572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 133254) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2018-04-02 |