| NPI | 1922758853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 74666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 32472) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2025-03-26 |