| NPI | 1528108347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 39097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 49838) |
| 207Q00000X Family Medicine (Licence: WI 48692) | |
| 207Q00000X Family Medicine (Licence: UT 9087963-1205) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2017-12-15 |