| NPI | 1467410647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60305393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 44556) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2023-07-12 |