| NPI | 1386265676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 320161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10072201) |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2023-08-10 |