| NPI | 1750906988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 91083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V0953) |
| 207Q00000X Family Medicine (Licence: GA 92671) | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2025-01-17 |