| NPI | 1942829387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 74971) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 0000000000000) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2023-08-21 |