| NPI | 1003197641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.145976) |
| 207Q00000X Family Medicine (Licence: LA 312179) | |
| 207Q00000X Family Medicine (Licence: FL ME157907) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2023-02-14 |