| NPI | 1366481418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 31916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 4873) |
| 207Q00000X Family Medicine (Licence: WI 62707) | |
| 208000000X Pediatrics (Licence: RI 11793) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-01-12 |