| NPI | 1033352737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-33820) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011001473) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2022-01-27 |