| NPI | 1598714933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 54144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 47079) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2022-04-18 |