| NPI | 1700015096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S2164) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 273180) |
| 207Q00000X Family Medicine (Licence: FL ME139592) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2022-05-23 |