| NPI | 1457481343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 6741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 44228) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2018-10-29 |