| NPI | 1992757264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68370) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD24537) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2024-02-20 |