| NPI | 1700854262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 47744) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 50883) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2024-01-29 |