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 |