| NPI | 1679681555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 27708) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 29974) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2011-11-22 |