| NPI | 1720028038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 54348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 23391) |
| 207Q00000X Family Medicine (Licence: ND 11867) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-10-04 |