| NPI | 1366751927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 55205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN PERMIT22868) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 55205) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2020-09-28 |