| NPI | 1861075061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14024467-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-2048) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-11-13 |