| NPI | 1497980056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 31911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012020685) |
| 207Q00000X Family Medicine (Licence: MN 60225) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2019-09-13 |