| NPI | 1245980150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13502724-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61674581) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2025-07-15 |