| NPI | 1699126169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10691) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2020-11-04 |