| NPI | 1952864076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 74574) |
| 207Q00000X Family Medicine (Licence: WI 7908) | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2022-08-08 |