| NPI | 1790997112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M6371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A15325) |
| 207Q00000X Family Medicine (Licence: OH 34.012203) | |
| 207Q00000X Family Medicine (Licence: NC 2016-01271) | |
| 207Q00000X Family Medicine (Licence: VA 0102204739) | |
| 207Q00000X Family Medicine (Licence: NY 286780) | |
| Enumeration Date | 2007-05-06 |
| Last Update Date | 2022-04-28 |