| NPI | 1619266608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2021037240) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 57805) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2022-04-07 |