| NPI | 1821041666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 5052) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-4681) |
| 207Q00000X Family Medicine (Licence: LA 026081) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2012-12-26 |