| NPI | 1740419712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A116565) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2020-11-05 |