| NPI | 1689256927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD484197) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10074686) |
| 207Q00000X Family Medicine (Licence: TX T8822) | |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-06-23 |