| NPI | 1609220466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 62488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 71541-20) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2019-08-07 |