| NPI | 1811257462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8699736-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD171322) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2026-06-08 |