| NPI | 1659527331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 114766) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2021-05-18 |