| NPI | 1306402268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 318198) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U0126) |
| 207Q00000X Family Medicine (Licence: AZ 67831) | |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2026-09-08 |