| NPI | 1427369321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 29910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2010018000) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2022-07-21 |