| NPI | 1730683400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V9451) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB11111300) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2026-02-09 |