| NPI | 1003877127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 34117) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 2039) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2013-04-01 |