| NPI | 1184121576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY TP624) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2021-0999) |
| 207Q00000X Family Medicine (Licence: TX U4043) | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2025-02-21 |