| 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 |