| NPI | 1376596536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 51606) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 02958) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-05-04 |