| NPI | 1164428280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 39802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 30419) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2017-01-27 |