| NPI | 1164874913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 64169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 27704) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2023-01-11 |