| NPI | 1922441278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 58462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 65824-20) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2018-03-17 |