| NPI | 1477968972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 29001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 7258) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2017-04-05 |