| NPI | 1174515357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 34640-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301508402) |
| 207Q00000X Family Medicine (Licence: MN 36341) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2023-11-03 |