| NPI | 1700172962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD176335) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 6091) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2018-04-11 |