| NPI | 1508243866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 60956) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 60956) |
| 207Q00000X Family Medicine (Licence: MN 1508243866) | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2020-10-29 |