| NPI | 1184945024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8599946-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS-2351) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2026-06-07 |