| NPI | 1669900536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A164200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T2422) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2025-06-20 |