| NPI | 1780770966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO228295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M0264) |
| 207Q00000X Family Medicine (Licence: WA OP70068057) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2026-01-26 |