| NPI | 1487644985 |
|---|---|
| Former Name | MOUA VANG |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C206263) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 54717) |
| 207Q00000X Family Medicine (Licence: WI 47517) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2026-02-20 |