| NPI | 1942480868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 50930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 20554) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2020-09-17 |