| NPI | 1891350039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 78209) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T9681) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2026-04-02 |