| NPI | 1386608396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE NE18618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 18618) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2011-01-27 |