| NPI | 1144299264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AK 4093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 82-147) |
| 207Q00000X Family Medicine (Licence: AZ 12824) | |
| 207Q00000X Family Medicine (Licence: HI 13041) | |
| 208D00000X General Practice (Licence: ID M-8618) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2024-04-25 |