| NPI | 1508878778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 5777) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 8378) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2023-03-07 |