| NPI | 1366498818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 7512) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 10371) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2013-02-27 |