| NPI | 1891761268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 28625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 1509) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2007-07-08 |