| NPI | 1497934897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK AA 3683) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AK AA 3683) |
| 333600000X Pharmacy | |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2026-01-08 |