| NPI | 1801258801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 010354) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S6011) |
| 207Q00000X Family Medicine (Licence: CA 21475) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2026-08-31 |