| NPI | 1982810164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 20782) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 20782) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2011-08-09 |