| NPI | 1881641538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 28494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 5343) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2008-06-11 |