| NPI | 1811157571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0151) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A112696) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2012-04-03 |