| NPI | 1861460214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 185959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U4548) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2024-06-04 |