| NPI | 1700223930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 66218-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 58080) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2024-07-22 |