| NPI | 1689607418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 67504) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 0025311) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: ND 13197) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-12-07 |