| NPI | 1861477226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 27690) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 27240) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2021-01-20 |