| NPI | 1497849244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 20212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 26652) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-01-29 |