| NPI | 1548783269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 66307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL14619) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2022-07-21 |