| NPI | 1386807725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60444232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 54221) |
| 207Q00000X Family Medicine (Licence: ND RL10913) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2020-12-08 |