| NPI | 1851344634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 34827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-02346) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2022-11-01 |