| NPI | 1144806894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13958007-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 011749) |
| 207Q00000X Family Medicine (Licence: OK 9054) | |
| 207Q00000X Family Medicine (Licence: NV CL0767) | |
| 207Q00000X Family Medicine (Licence: FL OS22568) | |
| 207Q00000X Family Medicine (Licence: TX U0557) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-09-25 |