| NPI | 1790786564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 5307) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2012-06-22 |