| NPI | 1982643219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 10790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 50415) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2011-11-21 |