| NPI | 1902105240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q0334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A129794) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2016-04-27 |