| NPI | 1942697131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 60762) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND PT15068) |
| Enumeration Date | 2015-04-25 |
| Last Update Date | 2019-10-17 |