| NPI | 1689692220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 28401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 4729) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-01-19 |