| NPI | 1952741050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 61333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 13813) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2018-11-02 |