| NPI | 1386750065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-34530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R7944) |
| 207Q00000X Family Medicine (Licence: ND LT11339) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2015-11-05 |