NPI | 1336117605 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 29431) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 29431) |
Enumeration Date | 2006-03-10 |
Last Update Date | 2024-06-11 |