| NPI | 1316696966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 9903249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 13570233-1204) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2025-05-22 |