| NPI | 1215983549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 4745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 42451) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2022-03-28 |