| NPI | 1962899773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME128236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S2494) |
| 207Q00000X Family Medicine (Licence: DE C1-0013226) | |
| 207Q00000X Family Medicine (Licence: CT 64045) | |
| 207Q00000X Family Medicine (Licence: NY 280515) | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2019-12-09 |