| NPI | 1952808057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 74255) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 75737) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2024-01-15 |