| NPI | 1497018055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68229) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60488608) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-05-04 |