| NPI | 1366782567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9036325-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A12754) |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2025-03-20 |