| NPI | 1770543837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 3493) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 75952) |
| 207Q00000X Family Medicine (Licence: MN 64412) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2023-12-01 |