| NPI | 1386686582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK MEDO6546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-012707) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-11-28 |