| NPI | 1093704314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 106551) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-27191) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2025-10-31 |