| NPI | 1588631386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 46789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 44773) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2015-10-14 |