| NPI | 1679514285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 43109) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 8277) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-11-16 |