| NPI | 1831621051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68953) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ D01922311) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2021-12-13 |