| NPI | 1538145156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 27015) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 26415) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2016-08-18 |