NPI | 1669769162 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 55523) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 55523) |
207Q00000X Family Medicine (Licence: WI 76110) | |
Enumeration Date | 2011-07-05 |
Last Update Date | 2025-06-13 |