| NPI | 1720492242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME137545) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10050704) |
| 207Q00000X Family Medicine (Licence: TX R3734) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2025-02-19 |