| NPI | 1093121881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 124361) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 8307) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2018-07-06 |