| NPI | 1073243168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD225800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-11072) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-08-29 |