| NPI | 1235421942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 26814) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6454) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2018-06-06 |