| NPI | 1184907362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 27949) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP6634) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2023-06-22 |