| NPI | 1235174376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 46906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.15640R) |
| 207Q00000X Family Medicine (Licence: AR E3349) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2019-05-01 |