| NPI | 1356544092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 55097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA bs5264976) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2017-08-17 |