| NPI | 1396973921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 55952) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8755) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2024-01-10 |