| NPI | 1043242290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 75458) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 11080) |
| 207Q00000X Family Medicine (Licence: UT 53362991205) | |
| 207Q00000X Family Medicine (Licence: ND 10636) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2024-06-25 |