| NPI | 1376747030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 11158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND TRL 10626) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2022-03-25 |