| NPI | 1356655781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 56053) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL11611) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2019-07-11 |