| NPI | 1811093172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0013752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0064646) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-07-09 |