| NPI | 1396736443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 8067) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 41143) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2022-08-15 |