| NPI | 1235166216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 5146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7197A) |
| 207Q00000X Family Medicine (Licence: ID M8408) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2017-09-08 |