| NPI | 1740817535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 12375529-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO3416) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-11-25 |