| NPI | 1134311541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 54943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 50811) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2022-05-13 |