| NPI | 1427540327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023031789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 29186) |
| 207Q00000X Family Medicine (Licence: MN 66368) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2024-09-24 |