| NPI | 1619235736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 11431575-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 15746) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2025-02-17 |