| NPI | 1225200769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2012011150) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 50529) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2017-03-14 |