| NPI | 1861465478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 53160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 20239) |
| 207Q00000X Family Medicine (Licence: WI 65830) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2024-04-23 |