| NPI | 1982685202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 32887) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 35188) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2023-11-22 |