| NPI | 1306955521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 32509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 16150-2) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-11-06 |