| NPI | 1548277353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019003502) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 47119) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2021-11-29 |