| NPI | 1174265904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101286403) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10078986) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2025-07-17 |