| NPI | 1497405930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 74731) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 32623) |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2023-08-03 |