| NPI | 1386649390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0003561) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 017982) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2015-01-21 |