| NPI | 1659755320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 11377208-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A23406) |
| 207Q00000X Family Medicine (Licence: AZ 011122) | |
| 207Q00000X Family Medicine (Licence: MO 2015020391) | |
| 207Q00000X Family Medicine (Licence: NV DO2594) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2024-12-06 |