NPI | 1154346237 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 48711) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 102390) |
Enumeration Date | 2006-07-12 |
Last Update Date | 2023-06-22 |