| NPI | 1346572062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52779) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 13662) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: ND 13662) | |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2024-03-29 |