| NPI | 1760801153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8526216-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2019-0762) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2022-01-07 |