| NPI | 1245221647 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 38780) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: MN 38780) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MN 38780) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MN 38780) | |
| 207V00000X Obstetrics & Gynecology (Licence: MN 38780) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2016-08-30 |