| NPI | 1275529240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60758090) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2023-02-08 |