| NPI | 1407963226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 57527) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 3980) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-07-09 |