| NPI | 1497771570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 45889) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 46187) |
| 207Q00000X Family Medicine (Licence: MN 46187) | |
| 207KA0200X Allergy & Immunology Allergy (Licence: MN 46187) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-04-30 |