| NPI | 1336661644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 66521) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-46474) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2020-07-07 |