| NPI | 1831125657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 3948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 23330) |
| 207Q00000X Family Medicine (Licence: ND 3994) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2024-04-30 |