| NPI | 1699114488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 58025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 65589-20) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2021-10-19 |