| NPI | 1205276086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2024-01122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9695910-1204) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2024-06-19 |