| NPI | 1083838411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 10986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL10241) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2020-09-22 |