| NPI | 1124356613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01066883) |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2026-01-29 |