| NPI | 1750938247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME153929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V3121) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2024-08-07 |