| NPI | 1013010099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M3736) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03400) |
| 207Q00000X Family Medicine (Licence: MN 63740) | |
| 207Q00000X Family Medicine (Licence: WI 56069) | |
| 207Q00000X Family Medicine (Licence: NJ 25MB09130600) | |
| 207Q00000X Family Medicine (Licence: CA 11695) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2021-12-01 |