| NPI | 1699269324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 65961) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 29244) |
| Enumeration Date | 2018-06-16 |
| Last Update Date | 2022-02-04 |