| NPI | 1487746442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 51700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 295252) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2022-07-14 |