| NPI | 1972740942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11259) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N1746) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2013-04-22 |