| NPI | 1760062921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-16249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10079256) |
| 207Q00000X Family Medicine (Licence: WY 184-T1) | |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2023-01-19 |