| NPI | 1588191902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13447082-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 081963) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2023-12-29 |