| NPI | 1356632590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 32007) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 88829) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NY 192249) | |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2021-04-06 |