| NPI | 1679559298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 38787-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 5163) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2024-02-19 |