| NPI | 1437419603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 56703) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-38413) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2020-08-03 |