| NPI | 1336645282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 65853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 29290) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2020-08-25 |