| NPI | 1871572057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 34650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 42710) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2021-02-22 |