| NPI | 1417934563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 1638) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD9415) |
| 207Q00000X Family Medicine (Licence: NE 17260) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2021-07-28 |