| NPI | 1487113056 |
|---|---|
| Former Name | ZACHARY BRIAN GOTTLEIB |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX S7664) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX S7664) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2022-04-22 |