| NPI | 1093026882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 31440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7496) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2021-02-05 |