| NPI | 1891811618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-06467) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-11-06 |