| NPI | 1629330535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 1178) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015015493) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2020-06-17 |