| NPI | 1144247008 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 7537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 40919) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2012-01-18 |