| NPI | 1649214362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 2498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 5461) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2012-02-08 |