| NPI | 1225023997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 42537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 66444) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2019-12-12 |