| NPI | 1902858855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 63043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA md00035349) |
| 207Q00000X Family Medicine (Licence: NH 13084) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2022-10-10 |