| NPI | 1629349576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2021-0456) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0146391) |
| 207Q00000X Family Medicine (Licence: AZ 1629349576) | |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2021-08-20 |