| NPI | 1629068325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE NE22341) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 22341) |
| 207Q00000X Family Medicine (Licence: NE 19365) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2020-10-29 |