| NPI | 1568511970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 61268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 22100) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-03-07 |