| NPI | 1003966003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 22527) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 33269) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-02-25 |