| NPI | 1750318010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 4624) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH nh4624) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2015-10-20 |