| NPI | 1285947556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 56409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301097176) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2023-03-15 |