| NPI | 1982866505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 53979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301081690) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2023-10-23 |