| NPI | 1821580994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 33888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP8279) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2023-08-01 |