| NPI | 1184327835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14164826-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 18969) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-09-02 |