| NPI | 1760419170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX P1671) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NJ 25MB07630200) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2024-04-20 |