| NPI | 1700291085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 28975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP7256) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2023-01-24 |