| 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 | 2025-08-08 |