| NPI | 1932195849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E1832) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 3822) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2012-09-20 |