| NPI | 1164514071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-13922) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5712112-1204) |
| 207Q00000X Family Medicine (Licence: AR R-4603) | |
| 207Q00000X Family Medicine (Licence: MO 30850) | |
| 207Q00000X Family Medicine (Licence: ND 6206) | |
| 207Q00000X Family Medicine (Licence: OK 3392) | |
| 207Q00000X Family Medicine (Licence: WA 1103) | |
| 207P00000X Emergency Medicine (Licence: KS 0513922) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2008-05-15 |