| NPI | 1407309479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE TEP7741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 320797) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2021-12-09 |