| NPI | 1346405602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 11895) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP5877) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2022-03-25 |