| NPI | 1770578007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T2334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A51210) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2022-07-14 |