| NPI | 1528252764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 49737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 57530) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2021-03-17 |