| NPI | 1487686689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 5229) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 27730) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-11-28 |