| NPI | 1942514666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 71485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL11612) |
| 207Q00000X Family Medicine (Licence: ND 12783) | |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2023-04-20 |