| NPI | 1093410664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 33477) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2024-07-31 |