| NPI | 1639556574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72070) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M13907) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2023-05-03 |