| NPI | 1689195380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 6082359-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO5491) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-07-21 |