| NPI | 1033779251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 69317) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-09948) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2022-09-15 |