| NPI | 1558597377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 55725) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 39814) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2024-10-09 |