| NPI | 1174571079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 28103) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 36850) |
| 207P00000X Emergency Medicine (Licence: WI 28103) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-02-09 |