NPI | 1184701856 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 10297) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 52145) |
Enumeration Date | 2006-11-01 |
Last Update Date | 2020-12-23 |