| NPI | 1982792982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD14668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 54667) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2013-02-26 |