NPI | 1619263324 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 63626) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-04547) |
207Q00000X Family Medicine (Licence: WI 61870-21) | |
Enumeration Date | 2011-06-21 |
Last Update Date | 2018-09-26 |