| NPI | 1992788475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 34531) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MN 34531) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2010-12-06 |