| NPI | 1053805887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-43746) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-09622) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2021-06-28 |