| NPI | 1447645049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q9296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09866700) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2024-09-12 |