| NPI | 1033175401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-01300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 45533) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2014-07-04 |