| NPI | 1952096323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14274495-1204) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 011595) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2026-07-07 |