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 |