| NPI | 1063074789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD215853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 12439658-1205) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2023-09-06 |