| NPI | 1558479956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ AZ2546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-40808) |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2018-05-17 |