| NPI | 1659698512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 54115) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 256931) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2024-01-18 |