| NPI | 1487036158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 70728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015019300) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2022-03-11 |