| NPI | 1174843643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14197633-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS007588L) |
| 207Q00000X Family Medicine (Licence: NV DO2844) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2026-06-30 |