| NPI | 1083692172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 33394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 50077) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2023-03-13 |