| NPI | 1710123575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A19334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 4812380-1204) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2026-01-13 |