| NPI | 1063527570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 35370) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 42535) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-03-16 |