| NPI | 1699295444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5321468-1234) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 12088) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2024-05-24 |