| NPI | 1134357239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9849340-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2011-01336) |
| 207Q00000X Family Medicine (Licence: WA MD60216841) | |
| 207Q00000X Family Medicine (Licence: ID M-13326) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2026-08-02 |