| NPI | 1508494949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V0462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 322974) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2024-07-15 |