| NPI | 1275779035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P5147) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 23613) |
| 207Q00000X Family Medicine (Licence: PA MT191103) | |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2019-03-22 |