| NPI | 1922368935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 28304) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6671) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2016-09-01 |