| NPI | 1609895879 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 6693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 41077) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2015-12-29 |