| NPI | 1346247236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 24201) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 30684) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-07-21 |