| NPI | 1033568787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-42305) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 201839154) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2021-02-23 |