| NPI | 1952893844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14196576-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 72281-21) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2025-03-18 |