| NPI | 1528050937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 20288) |
| Additional Taxonomies | 174400000X Specialist (Licence: SD 6004) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2012-01-26 |