| NPI | 1588681589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 3761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 23020) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2012-01-06 |