| NPI | 1508882135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME111513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 48659) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2021-10-04 |