| NPI | 1194386615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 2350) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 8455) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2023-09-12 |