| NPI | 1386819480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD188634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 62373) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2024-12-19 |