| NPI | 1285737544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002918A) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2013-05-20 |