| NPI | 1437948262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 83054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 35218) |
| Enumeration Date | 2025-05-06 |
| Last Update Date | 2026-07-14 |