| NPI | 1083105936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U9980) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R76661) |
| Enumeration Date | 2018-05-27 |
| Last Update Date | 2026-03-12 |