| NPI | 1760458293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P6360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 230349-1) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2022-03-03 |