| NPI | 1801055462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 250854) |
| Enumeration Date | 2008-06-08 |
| Last Update Date | 2016-08-15 |