| NPI | 1508090523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 12713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 52933) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2022-04-15 |