| NPI | 1326004102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 49598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 4979070-1205) |
| 207Q00000X Family Medicine (Licence: MN 53968) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2016-05-10 |