| NPI | 1649731084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68174) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 30247) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2023-01-25 |