| NPI | 1760594717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L6712) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-06-15 |