| NPI | 1356070940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 35546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V7857) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-05-20 |