| NPI | 1033372347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-42994) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 58423) |
| 207Q00000X Family Medicine (Licence: WI 55436-20) | |
| 207Q00000X Family Medicine (Licence: NC 2010-00520) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2018-04-24 |