| NPI | 1326498452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 19842) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 33386) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-07-27 |