| NPI | 1659548584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 56716) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 52078) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2013-01-30 |