| NPI | 1972694792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A43091) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J9772) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-11-19 |