| NPI | 1417034125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 15048) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 2516) |
| 207Q00000X Family Medicine (Licence: MO MDR4H16) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |