| NPI | 1417924481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 31706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 66991-20) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2021-07-29 |