| NPI | 1871537506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 67487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 43599) |
| 208D00000X General Practice (Licence: WI 43599) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-07-06 |