| NPI | 1437773603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 71105) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101273463) |
| 207Q00000X Family Medicine (Licence: VA 0101273463) | |
| 207R00000X Internal Medicine (Licence: VA 0101273463) | |
| 208000000X Pediatrics (Licence: VA 0101273463) | |
| 207P00000X Emergency Medicine (Licence: VA 0101273463) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101273463) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101273463) | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2026-04-24 |