| NPI | 1013221969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2011-02222) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 49044) |
| 207Q00000X Family Medicine (Licence: LA 342642) | |
| 207Q00000X Family Medicine (Licence: MS 33650) | |
| 207Q00000X Family Medicine (Licence: IL 036170828) | |
| 207Q00000X Family Medicine (Licence: TX Q1936) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2025-06-17 |