| NPI | 1023217528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 75118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53427-020) |
| 207Q00000X Family Medicine (Licence: OR MD159670) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2023-09-18 |