| NPI | 1124058847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 25513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 42277-020) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2021-02-18 |