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 |