| NPI | 1679909998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 19170) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2013-09-18 |