| NPI | 1790793412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2013-0983) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 24082) |
| 207Q00000X Family Medicine (Licence: TX L6070) | |
| 207Q00000X Family Medicine (Licence: FL ME105326) | |
| 207Q00000X Family Medicine (Licence: NY 268199-1) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2016-07-25 |