| NPI | 1023276896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-33918) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 61280) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2020-02-21 |