| NPI | 1700011459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 11662) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN TP105148) |
| 207Q00000X Family Medicine (Licence: MN 53565) | |
| 207Q00000X Family Medicine (Licence: ND RL11211) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2019-02-25 |