| NPI | 1326165606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-26686) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME42510) |
| 207Q00000X Family Medicine (Licence: MO MD112172) | |
| 207Q00000X Family Medicine (Licence: OK 20563) | |
| 207Q00000X Family Medicine (Licence: IN 01055598A) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |