| NPI | 1467489039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 3775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 28271) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2022-04-06 |