| NPI | 1164874574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 65984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10701) |
| Enumeration Date | 2016-07-09 |
| Last Update Date | 2019-08-14 |