| NPI | 1023109261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 43598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7207A) |
| 207Q00000X Family Medicine (Licence: FL ME122990) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2024-12-31 |