| NPI | 1780948778 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 28787) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 28787) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2021-04-20 |