| NPI | 1346733011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME163186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T4465) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2023-08-24 |