| NPI | 1548617061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S0619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 300420) |
| 207Q00000X Family Medicine (Licence: FL ME150167) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2023-11-14 |