| NPI | 1225050875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 37684-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 38749) |
| 207Q00000X Family Medicine (Licence: ND 6959) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-07-09 |