| NPI | 1962713883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 54136) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 54136) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2021-03-22 |