| NPI | 1689608291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK MD2799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2009024604) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2010-07-26 |