| NPI | 1528059375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 35570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41127) |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2019-08-01 |