| NPI | 1679865786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 74467) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 27497) |
| Enumeration Date | 2011-05-07 |
| Last Update Date | 2024-06-27 |