| NPI | 1386811198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8179) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME146695) |
| 207Q00000X Family Medicine (Licence: HI MD-21320) | |
| 207Q00000X Family Medicine (Licence: GA 059288) | |
| 207Q00000X Family Medicine (Licence: NC 141451) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2023-08-04 |