| NPI | 1316226442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 17549) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2019-01401) |
| Enumeration Date | 2011-08-07 |
| Last Update Date | 2019-05-28 |