| NPI | 1285927301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 57037) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 12979) |
| 207Q00000X Family Medicine (Licence: ND RL11874) | |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2014-11-21 |