| NPI | 1710951900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 52719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 33644) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-10-06 |