| NPI | 1639130404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A6137) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L2918) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-07-21 |