| NPI | 1568449270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 23377) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 23377) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2012-02-06 |