| NPI | 1801811971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 9822) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 48478) |
| 207Q00000X Family Medicine (Licence: WI 49109) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2024-02-14 |