| NPI | 1922990704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 1196523) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: TX 1196523) |
| Enumeration Date | 2025-07-16 |
| Last Update Date | 2025-07-16 |