| NPI | 1730178617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 49335) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 49335) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MN 49335) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MN 49335) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MN 49335) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2012-09-23 |