| NPI | 1598705535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 64756) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R1J32) |
| 207P00000X Emergency Medicine (Licence: MO R1J32) | |
| 207Q00000X Family Medicine (Licence: LA 310673) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2024-12-11 |