| NPI | 1972681963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C 51460) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J 0375) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-11-30 |