| NPI | 1598343741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72131) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 31647) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2022-07-22 |