| NPI | 1356090690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V9688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD490139) |
| 207Q00000X Family Medicine (Licence: NJ 25IA12995500) | |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-02-02 |