| NPI | 1336137728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 2011) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR N5898) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2015-08-17 |