| NPI | 1750701793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 122021) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 177947) |
| 207Q00000X Family Medicine (Licence: DE C1-0013129) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2022-03-29 |