| NPI | 1720373061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 1026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6543) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2014-09-29 |