| NPI | 1134758576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81088) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 73014) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2023-03-30 |