| NPI | 1124120431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 38035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 53810) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2015-02-18 |