| NPI | 1629170402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M4888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 232796) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2015-01-21 |