| NPI | 1770978181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207SG0201X Medical Genetics, Clinical Genetics (M.D.) (Licence: NY 279710) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX R0826) |
| 208D00000X General Practice (Licence: PA MD459716) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2022-07-21 |