| NPI | 1447241799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 44791) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: MN 44791) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: MN 44791) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: MN 44791) | |
| 207V00000X Obstetrics & Gynecology (Licence: MN 44791) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2007-07-08 |