| NPI | 1639563265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 63076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-01577) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2020-09-18 |