| NPI | 1841273703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 53741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002719A) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2011-10-19 |