| NPI | 1235237538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52383) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 37064) |
| 208VP0000X (Licence: WI 37064) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2025-11-19 |