| NPI | 1205905452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 43830) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53272-20) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-05-04 |