| NPI | 1508881186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: MN 26920) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: MN 26920) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2011-08-16 |