| NPI | 1679899892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 14785) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2023-05-10 |