| NPI | 1407969140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N5030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A65256) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-02-04 |