| NPI | 1376838839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 9241) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WY 9416A) |
| 207Q00000X Family Medicine (Licence: MN 73544) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2024-11-08 |