| NPI | 1790700714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD07348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 5721) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-02-24 |