| NPI | 1265695241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 32223) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 5825) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2023-02-02 |