| NPI | 1528418175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 1819) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 7698) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2020-03-04 |