| NPI | 1902435886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 69556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 30889) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2024-01-18 |