| NPI | 1841281425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 32964) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 30935) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2010-07-12 |