| NPI | 1932141157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 61281) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 26727) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-06-26 |