| NPI | 1538126107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 45172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 74308) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2024-12-12 |