| NPI | 1730282666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0062190) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OK 22462) |
| 173000000X Legal Medicine (Licence: OK 22462) | |
| 207Q00000X Family Medicine (Licence: DE C1-0009568) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2013-07-17 |