| NPI | 1164643789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 44721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-32629) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2011-10-05 |