| NPI | 1114944113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 6161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 36008) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2012-01-06 |