| NPI | 1902391857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14071413-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2018-0571) |
| 207Q00000X Family Medicine (Licence: ID M-15889) | |
| Enumeration Date | 2018-06-23 |
| Last Update Date | 2024-12-30 |