| NPI | 1083300743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14280315-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-2243) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2026-07-21 |