| NPI | 1710181151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 25477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP # 5214) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2017-03-13 |