| NPI | 1164725388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 16320) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 22217) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2010-12-09 |