| NPI | 1053808501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 12424228-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 311812) |
| 207Q00000X Family Medicine (Licence: OR MD211549) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: UT 12424228-1205) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: UT 12424228-1205) | |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2024-04-15 |