| NPI | 1750589651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 4667) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R1039) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2010-01-13 |