| NPI | 1336138262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 13691) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0055075) |
| 207Q00000X Family Medicine (Licence: AK 6861) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2015-10-12 |