| NPI | 1477662088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 48756) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MN 48756) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-01-24 |