| NPI | 1457559684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 56274) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 13215) |
| 207Q00000X Family Medicine (Licence: AZ 42245) | |
| 207Q00000X Family Medicine (Licence: MN 56274) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2021-01-07 |