| NPI | 1245896422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-01082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10067179) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2022-09-20 |