| NPI | 1720368079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q3619) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MB09023300) |
| 207Q00000X Family Medicine (Licence: NJ 25MB09023300) | |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2021-07-21 |