| NPI | 1699736140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0011654) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 036625) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2016-08-02 |