| NPI | 1346657558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8874) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.143535) |
| 207Q00000X Family Medicine (Licence: NY 274346-223) | |
| Enumeration Date | 2014-07-20 |
| Last Update Date | 2022-07-21 |