| NPI | 1982664637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 39823) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD27884) |
| Enumeration Date | 2006-03-26 |
| Last Update Date | 2021-03-26 |