| NPI | 1316263692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101283787) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0086733) |
| 207Q00000X Family Medicine (Licence: TX U5904) | |
| 207Q00000X Family Medicine (Licence: MD D86733) | |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2025-08-27 |