| NPI | 1700151016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD206492) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: LA 206492) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: LA 206492) | |
| 207Q00000X Family Medicine (Licence: TX Q3415) | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2024-05-16 |