| NPI | 1447348040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 26084) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 27272) |
| 207W00000X Ophthalmology (Licence: MN 26084) | |
| 208D00000X General Practice (Licence: MN 26084) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-10-11 |