| NPI | 1346489937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME152591) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10031137) |
| 207Q00000X Family Medicine (Licence: NM MD2011-0207) | |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2022-08-05 |