| NPI | 1457313124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 42746) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD RL-0256) |
| 207Q00000X Family Medicine (Licence: IA 33011) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2014-04-24 |