| NPI | 1114972221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD RL-0437) |
| 207Q00000X Family Medicine (Licence: MN TP-104372) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2011-10-18 |