| NPI | 1043650633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0988) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 7859) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2016-12-14 |