| NPI | 1457381980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 25477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 4728) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2011-10-21 |