| NPI | 1932173879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 35093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 36347) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2023-06-01 |