| NPI | 1609185263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 6871697) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA MD-44379) |
| 207Q00000X Family Medicine (Licence: MN PERMIT22870) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN PERMIT22870) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2026-02-26 |