| NPI | 1124161922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN MN38102) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 38102) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2024-08-02 |