| NPI | 1609886100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 34858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 38261) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2015-11-06 |