| NPI | 1952564627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8847116-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 275405-1) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2017-01-25 |