| NPI | 1588721195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK s3737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 3737) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2018-01-10 |