| NPI | 1376505115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 34151) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 3765) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-07-08 |