| NPI | 1700858933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 39942) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 42574) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2023-05-31 |