| NPI | 1902255847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 12357371-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116029272) |
| 207Q00000X Family Medicine (Licence: CA A154803) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2022-05-31 |