| NPI | 1568967909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS23133) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T3491) |
| 207Q00000X Family Medicine (Licence: TX T3491) | |
| 208D00000X General Practice (Licence: TX T3491) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2026-01-20 |