| NPI | 1114028735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 40946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 6474) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-11-17 |