| NPI | 1972549152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 47403) |
| Additional Taxonomies | 207QB0002X Family Medicine, Bariatric Medicine (Licence: MN 47403) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2019-11-11 |