| NPI | 1073592077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 37212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53516) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2020-07-15 |