| NPI | 1396181905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 52885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 72253-20) |
| 207Q00000X Family Medicine (Licence: MN 75238) | |
| 207Q00000X Family Medicine (Licence: WY 16185C) | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2024-03-15 |