| NPI | 1780260414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD220011) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U0582) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2026-10-17 |