| NPI | 1356879845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A197967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX u6722) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2024-08-14 |