| NPI | 1962995316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 74473) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-09581) |
| 207Q00000X Family Medicine (Licence: IA MD-48646) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2023-09-08 |