| NPI | 1366475774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 49657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 23916) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2021-01-27 |