| NPI | 1427085711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK AK6045) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD25147) |
| 207Q00000X Family Medicine (Licence: UT 375282-1205) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2012-01-31 |