| NPI | 1326275082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 7891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 5233) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2015-08-04 |