| NPI | 1700856911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 13899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 31087) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2018-11-21 |