| NPI | 1053362426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 50780) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 45522) |
| 207Q00000X Family Medicine (Licence: MO AB8216841) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2016-08-31 |