| NPI | 1427276260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 12048) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 51215) |
| 207Q00000X Family Medicine (Licence: ND PT 12048) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2022-12-15 |