| NPI | 1417067661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 76847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 43419) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-07-15 |