| NPI | 1659075562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 33333) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2024-07-25 |