| NPI | 1497841910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 6163) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O-0361) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2015-05-07 |