| NPI | 1922428077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 62705) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MN 62705) |
| 208D00000X General Practice (Licence: IA MD-44699) | |
| 207Q00000X Family Medicine (Licence: AR E-11506) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2021-04-05 |