| NPI | 1962485714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 38753) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: AZ 34215) |
| 207Q00000X Family Medicine (Licence: AZ 34215) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2023-05-03 |