| NPI | 1992772628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 50398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 46503) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2021-08-18 |