NPI | 1013985142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 32794) |
Additional Taxonomies | 174400000X Specialist (Licence: MN 32794) |
Enumeration Date | 2006-03-14 |
Last Update Date | 2016-07-07 |