| NPI | 1518958214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 18675) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: MN 18675) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2010-07-01 |