| NPI | 1255624490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME120850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-02433) |
| 207Q00000X Family Medicine (Licence: TX U5787) | |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2025-11-11 |