| NPI | 1003835984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 49213) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 9879) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-11-18 |