| NPI | 1093402760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 84282-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 100490) |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2026-10-01 |