| NPI | 1093795163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB05700100) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2013-04-09 |