| NPI | 1992369805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 80408) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A177399) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2025-11-14 |