| NPI | 1659710374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 64730) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R73957) |
| Enumeration Date | 2013-06-15 |
| Last Update Date | 2019-01-29 |