| NPI | 1154392447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 39223) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 36268) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2019-05-10 |