| NPI | 1124085121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX t5516) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 44642) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2026-01-28 |