| NPI | 1922088855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 33940) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 33940) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2011-12-10 |