| NPI | 1669450904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 24865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 18605) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-08-21 |