| NPI | 1033213228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 48685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 55326) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2024-05-06 |