| NPI | 1972682532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 8008) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 40268) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2016-03-25 |