| NPI | 1164409215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 30024) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 75197) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2024-08-02 |