| NPI | 1154448892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 42993) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 42993) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-10-29 |