| NPI | 1679927602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101023468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T0895) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2026-05-26 |