| NPI | 1255513529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 64917) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 71895) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2024-11-05 |