| NPI | 1962474858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 34607) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 29869) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2019-01-29 |