| NPI | 1134277155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1471) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 256256) |
| 207Q00000X Family Medicine (Licence: NJ 25MA08161900) | |
| 207R00000X Internal Medicine (Licence: TX Q1471) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2024-09-19 |