| NPI | 1831334424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 52400) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2021-01-07 |