| NPI | 1144909748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10090041) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 60-P122921-01) |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2024-07-15 |