| NPI | 1063553188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-33249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2007001609) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2024-06-17 |