| NPI | 1316351844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 3276) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM DO2023-1040) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2025-12-19 |