| NPI | 1518547215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 77359) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 33101) |
| 207Q00000X Family Medicine (Licence: WI 9267) | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2025-11-21 |