| NPI | 1497001788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 1119) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1113) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2024-05-03 |