| NPI | 1992884456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM TM2020-1177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA72009) |
| 207Q00000X Family Medicine (Licence: VT 042-0011945) | |
| 207Q00000X Family Medicine (Licence: TX 59062) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2024-05-07 |