| NPI | 1174542385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q5307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34004147) |
| 207Q00000X Family Medicine (Licence: PA OS006001L) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-02-14 |