| NPI | 1124003389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 3878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD20793) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2017-12-22 |