| NPI | 1831201144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52538) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO-437) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-06-05 |