| NPI | 1699765693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 67918) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 075631) |
| 207Q00000X Family Medicine (Licence: WA MD60974043) | |
| 207Q00000X Family Medicine (Licence: HI MD-8090) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2020-07-23 |