| NPI | 1568519692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 30193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 7216) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2022-07-21 |