| NPI | 1083633598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 67181) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 30901) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-08-19 |