| NPI | 1104923184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 6539) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 42916) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-09-04 |