| NPI | 1124382908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 17207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 56501) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2017-03-07 |