| NPI | 1669709846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 53974) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT192772) |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2021-06-17 |