| NPI | 1144318155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-20839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 49) |
| 207Q00000X Family Medicine (Licence: WY 4551A) | |
| 207Q00000X Family Medicine (Licence: ND 6486) | |
| 207Q00000X Family Medicine (Licence: IA 3546) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |