| NPI | 1023282894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 51148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61159245) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2023-04-25 |