| NPI | 1912979345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 12326) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2018-03-21 |