| NPI | 1467807917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 75168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 306) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2024-11-08 |