| NPI | 1497240709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 69113) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL15205) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2021-07-26 |