| NPI | 1548769912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81548) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 69826) |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2024-09-24 |