| NPI | 1376564906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 6732) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 12286) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2014-03-05 |