| NPI | 1831153972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 27612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41795) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2012-01-27 |