| NPI | 1861671364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N3905) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA a95635) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2026-04-07 |