| NPI | 1851657563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T1255) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 279087) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2021-07-09 |