| NPI | 1386134369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 69892) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL15080) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2021-10-15 |