| NPI | 1053304576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 41049) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41803020) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2024-04-23 |