| NPI | 1710673470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14262954-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2267) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2026-07-27 |