| NPI | 1427285576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 308033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P4062) |
| 207Q00000X Family Medicine (Licence: MO 2015008266) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2022-01-17 |