| NPI | 1922073048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V3883) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A75819) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2025-10-02 |