| NPI | 1962462556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 051671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 45241) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2022-01-07 |