| NPI | 1194786673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 34774) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 38245) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2020-09-15 |