| NPI | 1639794803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 74392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11953) |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2023-08-08 |