| NPI | 1740368984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA g83999) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME151720) |
| 207Q00000X Family Medicine (Licence: TX T4994) | |
| 207Q00000X Family Medicine (Licence: HI MD20796) | |
| 207Q00000X Family Medicine (Licence: NY 310574) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2024-06-19 |