| NPI | 1831862622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 71959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 31725) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2022-08-17 |