| NPI | 1326334871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R4922) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.123068) |
| 207Q00000X Family Medicine (Licence: FL ME 119555) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2018-09-04 |