| NPI | 1396927364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 79423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD469005) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2025-06-03 |