| NPI | 1780708248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD442118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 243215) |
| 207Q00000X Family Medicine (Licence: TX N2999) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-10 |