| NPI | 1518996750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G5259) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX G5259) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2025-03-24 |