| NPI | 1487617205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 42071) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 39205-020) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2021-03-11 |