| NPI | 1336991827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 80626) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 34350) |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2025-09-04 |