| NPI | 1467012468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 33407) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP8621) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2022-09-19 |