| NPI | 1104302918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 33510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 8258) |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2021-07-31 |