| NPI | 1356413405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 15537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4384) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-03-07 |