| NPI | 1053004259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77558) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 33353) |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2024-08-09 |