| NPI | 1235115791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 40080) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 42002) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2026-06-19 |