| NPI | 1215999776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203645) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4042) |
| 207Q00000X Family Medicine (Licence: PA OS016284) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2019-07-18 |