| NPI | 1003882200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R9F28) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 2742) |
| 207Q00000X Family Medicine (Licence: MN 48304) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2016-02-11 |