| NPI | 1356458897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 46161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 26417) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-08 |