| NPI | 1467536524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 38012) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 98-01668) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-10-11 |