| NPI | 1144281122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 372285-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-14903) |
| 207Q00000X Family Medicine (Licence: WY 12808A) | |
| 207Q00000X Family Medicine (Licence: VA 0101246275) | |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2023-11-15 |