| NPI | 1801850946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 44915) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 44915) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2023-01-05 |