| NPI | 1235107335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 45730) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 48447) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2024-11-19 |