| NPI | 1992972756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 63036) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 12076) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2018-03-21 |