| NPI | 1235247404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2024-00903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L6059) |
| 207Q00000X Family Medicine (Licence: AL DO1006) | |
| 207Q00000X Family Medicine (Licence: CA 20A8765) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2024-09-18 |