| NPI | 1881858215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 53166) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 47585) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2016-12-20 |