| NPI | 1649562356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 64295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME126298) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2018-09-10 |