| NPI | 1285926360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 59493) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 13729) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2015-12-24 |