| NPI | 1407082639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 57240) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 53097) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2018-07-16 |