| NPI | 1689056681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 31071) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL13713) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2020-07-08 |