| NPI | 1174703102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101285427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N3424) |
| 207Q00000X Family Medicine (Licence: NM MD2024-0928) | |
| 207Q00000X Family Medicine (Licence: NC 2025-02016) | |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2025-07-02 |