| NPI | 1366430506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C43322) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G3608) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2022-04-27 |