| NPI | 1275517237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 45303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 49211) |
| 207Q00000X Family Medicine (Licence: CA A90426) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2008-12-02 |