| NPI | 1811345838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 140167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 110432) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2020-09-17 |