NPI | 1992097992 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 57670) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9105) |
Enumeration Date | 2011-05-09 |
Last Update Date | 2022-07-21 |