| NPI | 1952954703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102208257) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019022869) |
| 207Q00000X Family Medicine (Licence: TX T6844) | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2023-12-29 |