| NPI | 1316156227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 54782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-7919) |
| 207Q00000X Family Medicine (Licence: IA 37836) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-12-04 |