| NPI | 1508824467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: DE C1-0007844) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7632A) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2016-12-08 |