| 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 |