| NPI | 1225278583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.094066) |
| 207Q00000X Family Medicine (Licence: FL ME105935) | |
| 207Q00000X Family Medicine (Licence: NV 13422) | |
| 207Q00000X Family Medicine (Licence: VA 0101245870) | |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2015-03-31 |