| NPI | 1669769485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 30292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 56986) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2018-03-17 |