| NPI | 1720648249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 13817A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 72122) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-08-20 |