| NPI | 1760045140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME163260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S7591) |
| Enumeration Date | 2019-04-21 |
| Last Update Date | 2026-01-15 |