| NPI | 1275385445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 80315) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 34316) |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2025-07-15 |