| NPI | 1699709592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 36046) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 30341) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-04-29 |