| NPI | 1083279806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 32920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 8439) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2022-09-07 |