| NPI | 1215310610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 29737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP7580) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2021-09-07 |