| NPI | 1033556204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5136997-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R2276) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2026-04-16 |