| NPI | 1275982571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-00958) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A157892) |
| 207Q00000X Family Medicine (Licence: TX S8577) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2023-09-19 |