| NPI | 1245580315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 307261) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P2126) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2021-02-11 |