| NPI | 1619358264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA FS7258963) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 29887) |
| 207Q00000X Family Medicine (Licence: TX bp10051982) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2023-03-16 |