| NPI | 1265471296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-02129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 056816) |
| 207Q00000X Family Medicine (Licence: MN 36518) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2017-04-06 |