NPI | 1851377923 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 37579) |
Additional Taxonomies | 208D00000X General Practice (Licence: MN 37579) |
Enumeration Date | 2005-12-20 |
Last Update Date | 2016-08-18 |