| NPI | 1902073836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 55432-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 52106) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2011-08-23 |