| NPI | 1083691612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 57183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4036) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2024-05-14 |