| NPI | 1922636349 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V9314) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A190060) | 
| Enumeration Date | 2020-03-31 | 
| Last Update Date | 2025-06-17 |