NPI | 1346251311 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 24698) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 10360) |
Enumeration Date | 2006-08-11 |
Last Update Date | 2011-12-30 |