| NPI | 1376513663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 41532) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 44877) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2023-06-01 |