| NPI | 1912340597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 131028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 100992) |
| 208D00000X General Practice (Licence: HI MD-20461) | |
| 208D00000X General Practice (Licence: AK 131028) | |
| 207Q00000X Family Medicine (Licence: HI MD-20461) | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2021-09-29 |