| NPI | 1932172509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 2896) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 31383-021) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2007-07-08 |